SFD (0212-037)54052 Avenida Martinez
0212-037
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Licensee#,d } 9L1ic. Class Z Exp. Date/
Date _i I /Q&' Signature of Contractor
{ OWNER -BUILDER DECLARATION i
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of•the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700' of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ST,tyTRMD Policy No. MV06,99
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is'issued,
I shall not employ any person in any manney so asdo become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation`provislons of Section 3700 of the Labor
Code, l.shall forthwith comply with those provisions. f L
/Date: `!1 i!✓U .:d• Applicant / l ,•^ : : ( "
j
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person:at
whose request and for whose benefit work is performed under or pursuant to"—
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with allity, any Stateflaws relating to the building
construction, and hereby authorizIspection.
representatives of this City to enter upon
the above-mentioned property for purposes.
,,,,,Signature (Owner/Agent) r 't ' Date'
BUILDI_ G PERMIT PERMIT#
N
DATE f ACOATION _ 3; LOT 22 TRACT
ff
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JOB SITE ADDRESS -a-5 6 XMARa.i R11
APN 774-222'.-M3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
.CMI`Faii ic;0W. D.T.4'„„".JC3 :;I"l°"
,.IMPkWERPARTSES
PAUMR-81'N r CA VZ2 61
INDIO C.A. 9242011
1'Q760) 447-0.500 MAI h.95a8
USE OF PERMIT
'S`JNG1X:V.ANffLY,1)W. MUM
„ssru • Irml `Sqn Ryw0'fx'4C perait WBS NOT )MU& HIINI.,k.
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GAIR.AO)3!t''.APPOk'k OF
CON."!"5►,1➢(,'i'1O1. YZE, 101.000-418•000 $681.$0
lar} art CH0`fjK VfUt 101••000.439-.318 $586.00
FER DEPOSIT 101.000.4;9-318 4250.00
,MY,4,HAMCeALPEP, 101.000.421-000 V91.50
EV,C'T71.1CaAL WE 101.000>420-0e0 2122.07
PLU'>M.YU140 FM 101 -000-419-000 $140.7,
STROW0 MOTION' ME -111PMD 101.000.241-000 $11AS
ePWrG:119101-000-42.1-000 $15.00
DE C6O ER V}yF 1oF T%405.0
PItFZVZ? PL,A1+4' 101-Cil7t -441-345 $100.00
ssuys.'I'CY1n cops tY3aa=,tC7 4 r,mTr) PLA4 s;."T. mic
,143.57
..,S.00, F'1_UT,•PAX i T'e.'S3
4250,00
FEB 0 7 2003
CITYOFLA QUINTA
RECEIPT DA f
C
/
DATE FINALED
0
INSPECTOR
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
L�bsCi11
Underground Ducts
Forms & Footings
Slab Grade
_ dj
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
_
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
' J
Final
Final - G
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
.
Encapsulation
Gas Piping
Gas Test
. ra
Appliances
Final
Final
Utility Notice (Gas) - O
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final C95 oory
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 2/6/03 La Quinta, CA 92253
No. 24128 (760) 771-8515
Owner
Mountain Cove Development
Address
P.O.Box 3578
City
Palm Desert Zip 92261
Tract #
Permit #
Type
Single Family Residence
Lot #
Unit 1 22
Unit 2
Unit 3
Unit 4
Unit 5
Comments
No. Street
54052 Avenida Martinez
1FlED,sc o
Q BERMUDA DUNES r
Cn RANCHO MIRAGE
INDIAN WELLS
d PALM DESERT y
LA QUINTA
. QINDIO y
Q
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
.EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
intheamount of $2.14 X 1,851 S.F. or $3,961.14 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Canyon National Bank - Larry Shields Check No. 13143
Name on the check Telephone 760-771-1670
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S
Signature
ilvrey $3,961.14 $o.00
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
APN #
774-222-003
Jurisdiction
La Quinta
Permit #
0212-037
Study Area
No. of Units
1
S.F.
Lot # No.
Street
1851 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
.EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
intheamount of $2.14 X 1,851 S.F. or $3,961.14 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Canyon National Bank - Larry Shields Check No. 13143
Name on the check Telephone 760-771-1670
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by S
Signature
ilvrey $3,961.14 $o.00
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
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